Horizon Medicare Prescription Drug Plans

For Pharmacists

Horizon Blue Cross Blue Shield of New Jersey Payer Sheet Information for Medicare Part D
Marketing Names	MAPD: Horizon Medicare Blue Value w/ Rx Standard (HMO) Horizon Medicare Blue Value w/ Rx Enhanced (HMO) Horizon Medicare Blue Access w/ Rx Standard (HMO-POS) Horizon Medicare Blue Access w/ Rx Enhanced (HMO-POS) PDP: Horizon Medicare Blue Rx Standard (PDP) Horizon Medicare Blue Rx Enhanced (PDP)
Region	New Jersey
RXBIN	004336
RXPCN	HZRX
RXGRP	RX7098 RX7099 RX7100 RX7101 RX7104 RX7105
Secondary Information*	RXBIN: 012114 RXPCN: COBSEGADV
Phone Numbers (pre- and post-enrollment)	PDP and MAPD Pre-enrollment number 1-800-224-1234 Post Enrollment Numbers Toll-free number(s) PDP: 866-236-7376 MAPD: 866-236-7373 PAAD PDP: 866-236-7374 PAAD MAPD: 800-935-4102 Toll-free TTY number(s) 866-236-1069
Website (pre- and post-enrollment)	www.HorizonBlue.com/medicare
Grievance Phone Number	You may submit a grievance over the phone, by fax, or by letter. 1. To submit a grievance over the phone, call a grievance team member at 866-249-6176. 2. You may submit a grievance via fax at 866-788-5143. 3. Submit a grievance in writing to: Grievance Team, P.O. Box 280500, Nashville, TN 37228

*Secondary information applies when submitting claims to MAPD or PDP as secondary coverage.

PAAD and Senior Gold beneficiaries are also enrolled in a special secondary coverage. Please submit the primary claim to the MAPD or PDP coverage indicated above (from the beneficiary's card), and then a secondary claim to Unisys, RxBIN: 610515, RxPCN: PAAD, RxGRP: < not used >. See the beneficiary's card for the Member ID.